Comas Gabriel C, Galindo A, Martínez J M, Carrera J M, Gutiérrez-Larraya F, de la Fuente P, Puerto B, Borrell A
Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Institut Universitari Dexeus, Barcelona, Spain.
Prenat Diagn. 2002 Jul;22(7):586-93. doi: 10.1002/pd.372.
To examine the accuracy of early fetal echocardiography performed in a high-risk population combining transvaginal and transabdominal routes.
A series of 330 high-risk pregnancies were screened by transvaginal and transabdominal scan at 12-17 weeks' gestation in a prospective multicentre trial in Spain between September 1999 and May 2001. A total of 334 fetal heart examinations were performed, including four twin pregnancies. Maternal age ranged from 17 to 46 years (mean 33 years with 36% of women over 34 years). The median gestational age at scan was 14.2 weeks (range 12-17 weeks). For each fetus, visualization of the four-chamber view, the origin of the great arteries, aortic and ductal arches and systemic venous return was attempted in a segmental approach. B-mode and colour/pulsed Doppler flow imaging were used in all cases. The duration of complete heart examination was less than 30 minutes. The examinations were performed by three experienced operators. Reliability was assessed by conventional transabdominal echocardiography at 20-22 weeks, by postnatal follow-up in the first three months of life, and/or by autopsy in cases of termination of pregnancy.
The rate of successful visualization of the fetal heart was 94.6% (316/334). In 48 out of 334 (14.4%) fetuses the final diagnosis was abnormal. In 38 out of 48 (79.2%) cases with heart defects the diagnosis was suspected at early echocardiography. In the group with congenital heart defects, 27 cases had an abnormal karyotype (56.3%) and 31 cases showed extracardiac anomalies (64.6%). There were 10 false-negative cases at early scan. There were no false-positive diagnoses.
This experience stresses the usefulness of early fetal echocardiography when performed by expert operators on fetuses specifically at risk for cardiac disease. The high rate of successful visualization of the fetal heart provides a reliable diagnosis of major cardiac defects at this early stage of pregnancy.
探讨经阴道和经腹途径对高危人群进行早期胎儿超声心动图检查的准确性。
在1999年9月至2001年5月西班牙进行的一项前瞻性多中心试验中，对330例高危妊娠孕妇在妊娠12 - 17周时行经阴道和经腹扫描。共进行了334次胎儿心脏检查，其中包括4例双胎妊娠。孕妇年龄在17至46岁之间（平均33岁，36%的孕妇年龄超过34岁）。扫描时的孕周中位数为14.2周（范围12 - 17周）。对每个胎儿，采用节段性方法尝试观察四腔心切面、大动脉起源、主动脉弓和动脉导管弓以及体静脉回流情况。所有病例均使用B型和彩色/脉冲多普勒血流成像。完整心脏检查的时间少于30分钟。检查由三名经验丰富的操作人员进行。通过20 - 22周时的传统经腹超声心动图、出生后前三个月的随访以及/或者妊娠终止时的尸检来评估可靠性。
胎儿心脏成功显像率为94.6%（316/334）。334例胎儿中有48例（14.4%）最终诊断异常。48例有心脏缺陷的病例中，38例（79.2%）在早期超声心动图检查时被怀疑有诊断。在先天性心脏缺陷组中，27例染色体核型异常（56.3%），31例有心脏外异常（64.6%）。早期扫描时有10例假阴性病例。无假阳性诊断。
该经验强调了由专业操作人员对有心脏病风险的胎儿进行早期胎儿超声心动图检查的有用性。胎儿心脏的高显像率为妊娠早期的主要心脏缺陷提供了可靠诊断。
